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AsNo.2050-=91IExp., .9,io:96) See Instructions an back of 6. <br /> ,/!L ran d or Deportee—of Toxic Substances Cmnu <br /> eumd use,an Afo(12-pitchl typonarmar. Sec'emm.California <br /> UNIFORM HAZARDOUS Gemenotor's US EPA to No.r Manifest Docume 2. Page I Information in the shaded.reas i is net required by Federal low. <br /> !Y <br /> jAjDqjM <br /> WASTE MANIFEST =1 <br /> of X <br /> 3. Gmoratol's Nam and Mailing Address <br /> N-urnber,, <br /> li-St ID <br /> A. Gamoreten'.Phone <br /> go 0 <br /> S. Tcumpcume,I Company Nam 31 1 1, <br /> 6. US EPA ID Number C. State Trurup,ria,',D <br /> Transporter <br /> soon <br /> rotor" <br /> Game <br /> N <br /> Ph <br /> r I om, <br /> C <br /> n <br /> I <br /> on <br /> of <br /> L <br /> M <br /> -mP y N <br /> � r" - <br /> Mailing <br /> ALLIED PETPOLELN Phcuw <br /> Company 209-5 <br /> compa a —ICIA11-10101011 1 2 3 1 4 , 76-13500 <br /> 7. Transporter 2 <br /> Nam. 8. US EPA ID Number <br /> U <br /> C0 ip.rtar" ph. <br /> 9 assfin F <br /> 414b:5 9. Desommad Facility Nam and Site Address <br /> Z 10. US EPA ID Number focii 's <br /> jf� <br /> Lr)as: MERICLEAN, INC. )D,;: <br /> 0 t213�51 8 14�� <br /> 2570 ALMOND DR. <br /> ne <br /> 'I LV <br /> ER S INC <br /> 'S - <br /> U SILVER SPRINGS All' FICIA90 <br /> 12. Contains. <br /> 11. US DOT Desoripfie.Cacludirtg Proper Shipping Nam,Hazard Cie.,and ID Number) -4 <br /> (D Z 13. Total 14, Unit <br /> No T Quantity Wt/v.11 <br /> 'Weran NumX <br /> G NON RCRA HAZARDOUS WASTE LIQUID 2-3 <br /> ET T EPA/Om.' <br /> N Is. <br /> 4 E state <br /> It <br /> AEPAI/OHw, <br /> T <br /> coe0 <br /> EPA/Other <br /> 1 Z <br /> — t. <br /> d. .State <br /> EPA/01h, <br /> Z <br /> 0 b., <br /> LAI <br /> Z <br /> LD 15. Special Handling Irefimlions and Additional Imforanafien <br /> 1— <br /> < WEAR PROTE7AVE GEAR <br /> Z 2A HR FACILUY 702-577-9001 <br /> W <br /> X 24 HR GENERATOR <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this comignatent are fully and accurately described above by proper shipping nom and are classified, <br /> U peeked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable International and national government regulations, <br /> If I am . large quantity generator. I .,Hy that I have . program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically Practicable and that I have whetted the practicable method of treatment,"age,or disposal currently available to me which minimizes the present and future <br /> res threat to human health and the mvinstsmort,OR, 9 1 am . mail quantity generator, I have made agood faith effort to minimize my waste generation and select the best <br /> W waste management method that is available to ete and that I can afford <br /> 0 Printed/Typed Noma Signatur, Momh Day Year <br /> >- F LAvzK A -7n� <br /> IU Z1 17. T,me,ter I A41eviscgevnt of Reooig <br /> of Mater.16 <br /> A Printed/Typed Signamur. Month Day Year <br /> If <br /> P i <br /> 0 KR, t1off I <br /> su Materials <br /> LL. T Pmaui/Typacl Nam. Signature Month Day Y. <br /> 0 E <br /> V) 19. Discrepancy Indication Space, <br /> 4 <br /> IF <br /> A <br /> Z C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in teem 19. <br /> T Printed/Typed Name Signestans Momh Day year <br /> Y Q t7 <br /> 4t�Z r <br /> Z11 Clt cia� <br /> 00 NOT WRITE BELOW THIS LINE. <br /> DISC 800A (1/95) Green: TRANSPORTER RETAINS <br /> EPA 8700-22 <br />